Psychological pain as existential grief in midlife: a constructivist grounded theory

Background Psychological pain is a well-established predictor of suicidal ideation and behavior. However, the ways in which this pain is subjectively experienced and made sense of during midlife, particularly among individuals who experience this period as a crisis, remain insufficiently understood. Midlife often involves intensified existential reflection and confrontation with discrepancies between imagined and lived life trajectories, a process that may be especially salient in non-Western sociocultural contexts where qualitative evidence remains limited. Within this context, the present study examined how adults who self-identified as experiencing a midlife crisis understand, describe, and live with psychological pain. Methods Using a qualitative design, in-depth semi-structured interviews were conducted with 18 urban Iranian adults aged 40 to 57 years who reported experiencing a midlife crisis. Data were analyzed following Charmaz’s constructivist grounded theory approach, with data collection and analysis proceeding concurrently. Results Psychological pain emerged not as a discrete emotional state, but as a dynamic and cyclical process conceptualized as existential grief. This process arose through confrontation with an irreversible discrepancy between the ideal self and the lived self. Participants described ongoing mourning for symbolic losses, including unrealized life possibilities and foreclosed identities. Regret, sorrow, helplessness, and profound loneliness were closely intertwined and mutually reinforcing. This experience unfolded as a self-perpetuating cycle, in which unresolved symbolic losses continuously reactivated psychological pain. Midlife-specific pressures and the lack of effective emotional relationships further intensified this process. When unresolved, existential grief culminated in psychological burnout, crisis of meaning, and suicidal ideation. Conclusion These findings suggest that psychological pain in midlife is better understood as an unfinished grieving process for symbolic, self-related losses rather than as emotional distress alone. Conceptualizing psychological pain as existential grief may sharpen clinical assessment by directing attention to self-discrepancy, histories of symbolic loss, and pain-related escape cognitions, with implications for suicide risk formulation and meaning-oriented clinical work with midlife adults.